VINBLASTINE AND DANAZOL THERAPY IN STEROID-RESISTANT CHILDHOOD CHRONIC IDIOPATHIC THROMBOCYTOPENIC PURPURA

Various drugs such as vinca alkaloids, immunoglobulins and immunosuppr essant drugs have been used with variable benefits in patients with ch ronic idiopathic thrombocytopenic purpura (CITP) refractory to steroid therapy. Vinblastine and danazol have been shown to decrease the expr ession of Fc (IgG) receptors on macrophages by different mechanisms. T hese two drugs were used in combination, with the presumption that the y will have an additive effect in the treatment of CITP. Sixteen patie nts with CITP between 2 and 17 years of age, resistant to steroids, we re treated with vinblastine given as an intravenous bolus dose at week ly intervals for 8 weeks (the induction phase), followed at monthly in tervals for the next 6 months (the maintenance phase). Danazol was giv en daily in doses of 2-3 mg/kg body weight during both phases. Ten of the 16 (62.5%) patients had partial to complete response and 5 of thes e 10 patients had sustained remission after cessation of therapy. The initial outcome with the combination of these two drugs in CITP appear s to be quite promising and requires further evaluation in a larger co ntrolled study.